Alcohol Reduction and 15-Year Cardiometabolic Changes in Glycemic, Lipid and Blood Pressure Profiles: A Target Trial
Takahiro Ichikawa1, Hiroshi Okada1,2, Shinta Yamamoto1
1Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Aims:
The long-term cardiometabolic effects of alcohol reduction remain unclear. We evaluated the long-term associations of sustained alcohol reduction with glycemic, blood pressure, and lipid profiles.
Materials And Methods:
We conducted a pooled sequential target trial emulation using annual health examination data from Japanese employees (2008-2023). Eligible participants were aged ≥ 40 years and consumed ≥ 20 g/day of ethanol at baseline. Participants subsequently reducing alcohol intake to < 20 g/day formed the intervention group; those maintaining ≥ 20 g/day formed the control group. We applied inverse probability weighting to estimate the per-protocol effect of sustained alcohol reduction. We used weighted generalized estimating equations to estimate longitudinal trajectories of fasting plasma glucose (FPG), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol.
Results:
Among 266 699 eligible trial entries, 30 280 and 229 946 trial entries were included in the intervention and control groups, respectively. Alcohol reduction was associated with persistently lower FPG, SBP, DBP, and triglycerides over 15 years. At Year 15, between-group differences were -1.8 mg/dL for FPG, -3.4 mmHg for SBP, -2.2 mmHg for DBP and -20.4 mg/dL for triglycerides (all p ≤ 0.005). Conversely, HDL cholesterol levels were consistently lower and LDL cholesterol levels modestly higher in the intervention group. Blood pressure-lowering effects were consistent across genders, and findings were broadly consistent across sensitivity, subgroup, and dose-transition analyses.
Conclusions:
Sustained alcohol reduction improved long-term FPG, blood pressure, and triglycerides. These findings support alcohol reduction as a potentially beneficial lifestyle intervention for improving cardiometabolic profiles.